A 65-Year-Old Man with Leg Pain While Walking

Abstract

Spinal stenosis represents a common cause of low back and lower extremity radiculopathy in middle-aged to older adults. While congenital etiology is possible, most of the focus is on canal narrowing that results from chronic spinal degeneration. As this patient population often exhibits other comorbidities associated with aging, clinicians should maintain a broad differential diagnosis. Both bilateral symptoms of central canal stenosis and unilateral pain caused by dynamic narrowing at the lateral recess or foramen may closely overlap with peripheral arterial disease, diabetic neuropathy, deep venous thrombosis, and even varicose veins. Furthermore, osteoarthritic change of the hip and knee joints may similarly produce lower extremity and back pain.  In addition, stress fractures and subclinical trauma may likewise mimic the exertional and positional element of spinal stenosis. Clinicians should maintain high clinical suspicion when encountering middle-aged and elderly patients with symptoms of neurogenic claudication. Many studies have attempted to assess the predictability of these anatomic changes in determining clinical diagnosis and treatment response. Importance is still placed on concomitant history, physical examination, and imaging studies in assessing disease severity.